Ankylosing spondylitis

Question 1

definition

Answer 1

chronic inflammatory disease of the spine and sacroiliac joints
unknown aetiology
M:F 6:1 at 16yo, 2:1 at 30yo
~90% are HLA B27 positive

Question 2

Sx and signs

Answer 2

typical patient:
30yo male, gradual onset lower back pain
worse at night
morning stiffness relieved by exercise
pain radiates from sacroiliac joint to hips/buttocks, and usually improves towards the end of the day
progressive loss of spinal movements - hence decreased thoracic expansion

Question 3

disease course

Answer 3

variable
a few with progress to kyphosis, neck hyperextension and spino-cranial ankylosis
other features include:
enthesitis (esp. achilles tendonitis), plantar fasciitis, at the tibial and ischial tuberosities, and at the iliac crests

anterior mechanical chest pain due to costochondritis and fatigue may occur

acute iritis in 1/3rd, which can lead to blindness if untreated
also ass. w/ osteoporosis, aortic valve incompetence and pulmonary apical fibrosis